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53	53	STATE OF OKLAHOMA
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55	55	1st Session of the 58th Legislature (2021)
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57	57	SENATE BILL 651 By: David
58	58
59	59
60	60
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63	63	AS INTRODUCED
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65	65	An Act relating to health insurance; amending 36 O.S.
66	66	2011, Section 4512, as amended by Section 1, Chapter
67	67	34, O.S.L. 2017 (36 O.S. Supp. 2020, Section 4512),
68	68	which relates to insured employer health benefit
69	69	plans; prohibiting insurer from canceling accident
70	70	and health policy without notice; requiring insurer
71	71	to explain reason for cancellation; and providing an
72	72	effective date.
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77	77	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
78	78	SECTION 1. AMENDATORY 36 O.S. 2011, Section 4512, as
79	79	amended by Section 1, Chapter 34, O.S .L. 2017 (36 O.S. Supp. 2020,
80	80	Section 4512), is amended to read as follows:
81	81	Section 4512. A. This section applies to an insured employer
82	82	health benefit plan providing health insuran ce to employees of
83	83	employers employing twenty (20) or more full -time or full-time-
84	84	equivalent employees.
85	85	B. An employer carrier, on written request from an insur ed
86	86	employer covered by that carrier, shall report to the employer
87	87	information from the twelve ( 12) months preceding the date of the
88	88	report regarding:
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140	140	1. The total amount of charges sub mitted to the carrie r for
141	141	persons covered under the employer health ben efit plan;
142	142	2. The total amount of premium payments made by the
143	143	policyholder to the insured car rier;
144	144	3. The total amount of payments made by the carrier to health
145	145	care providers for pe rsons covered under the plan, including the
146	146	total hospital charges, phy sician charges, and pharmaceutical
147	147	charges; and
148	148	4. For any claims for an individual paid in ex cess of Ten
149	149	Thousand Dollars ($10,000.00), information on claims paid, including
150	150	diagnostic evaluations.
151	151	C. An employer shall have to make a written request for
152	152	information. The employer may make one request per year prior to
153	153	the anniversary or renewal d ate. In addition, prior to the date of
154	154	a rate change, an employer may make additional wri tten requests for
155	155	the information, provided the employer shall not make more than one
156	156	additional request in any one (1) year.
157	157	D. Except as otherwise provided in this subsection, an employer
158	158	carrier shall provide the information provided for in this sectio n
159	159	not later than sixty (60) days before the anniversary or annual
160	160	renewal date, or thirty (30) days before the date of any rate change
161	161	action of the employer ’s benefit plan. Provided, if the carrier
162	162	receives the request from the employer less than sixty ( 60) days
163	163	before the anniversary or renewal date or less than thirty (30 ) days
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215	215	before the date of a rate change, the carrier shall have sixty (60)
216	216	days from the date o f receiving the request to provide the
217	217	information. Provided further, if the carrier requ ires the employer
218	218	to submit any changes to the benefit plan prior to th e anniversary
219	219	or annual renewal date, the carrier shall provide the information
220	220	not later than sixty (60) days before the date the employer is
221	221	required to submit any changes.
222	222	E. An employer carrier shall not report any information
223	223	required under this sect ion if the release of such information is
224	224	prohibited by federal law or regulation.
225	225	F. Claim information provided by an employer carrier under this
226	226	section shall be provided in the aggr egate, without infor mation
227	227	through which a specific individual covered by the health insurance
228	228	or evidence or coverage may be identified. Claim information shall
229	229	include the total claims made, the total claims paid, the total plan
230	230	charges and the head cou nt by coverage.
231	231	G. 1. If an employer carrier fails to provide the inf ormation
232	232	in the time required by subsection D of this section, the Insurance
233	233	Commissioner may, after notice and hearing, subject an insurer to a
234	234	civil penalty of One Hundred Dollars ($1 00.00) for each day that the
235	235	information is delinquent.
236	236	2. If an employer carrier has a risk -bearing contract with a
237	237	medical group, independent practice association (IPA), or management
238	238	services organization (MSO) that stipulates the delegation of claims
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290	290	payment, and the car rier satisfies the Insurance Commissioner that
291	291	the medical group, IPA, or MSO has failed to provide the information
292	292	to the employer carrier in a s ufficient time for the carrier to
293	293	comply with subsection D of this section, the Commission er may waive
294	294	the penalty provided for in paragraph 1 of this subsection .
295	295	3. The civil penalty may be enforced in the same manner in
296	296	which civil judgments may be enfo rced, as provided in Section 312A
297	297	of this title. Such penalties shall be placed in the St ate
298	298	Insurance Commissioner Revolving Fund. Any person aggrieved by the
299	299	determination of the Insurance Commissioner may seek judicial review
300	300	pursuant to Section 320 o f this title.
301	301	H. An employer carrier shall not cancel a group or individual
302	302	policy of existing coverage under an accident and health insurance
303	303	policy without providing notice to the policyholder at least thirty
304	304	(30) days prior to the cancellation. The notification shall explain
305	305	in sufficient detail the reason for the cancellation of the policy.
306	306	I. The Insurance Commissioner shall promulgate rules for the
307	307	implementation and administration of this section.
308	308	I. J. As used in this section, “employer carrier” means any
309	309	entity which provides health insurance in this state. For the
310	310	purposes of this section, employer c arrier includes a licensed
311	311	insurance company, not -for-profit hospital service or medical
312	312	indemnity corporation, a fraternal benefit society, a health
313	313	maintenance organization, a multiple employer welfare arrangement or
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365	365	any other entity providing a plan of health insurance or health
366	366	benefits subject to stat e insurance regulation.
367	367	SECTION 2. This act shall become effective Novemb er 1, 2021.
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369	369	58-1-1067 CB 1/21/2021 9:57:55 AM

Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB651 Compare Versions